Housing Code Violation Density Associated With Emergency Department And Hospital Use By Children With Asthma

Abstract

Local agencies that enforce housing policies can partner with the health care system to target pediatric asthma care. These agencies retain data that can be used to pinpoint potential clusters of high asthma morbidity. We sought to assess whether the density of housing code violations in census tracts—the in-tract asthma-relevant violations (such as the presence of mold or cockroaches) divided by the number of housing units—was associated with population-level asthma morbidity and could be used to predict a hospitalized patient’s risk of subsequent morbidity. We found that increased density in housing code violations was associated with population-level morbidity independent of poverty, and that the density explained 22 percent of the variation in rates of asthma-related emergency department visits and hospitalizations. Children who had been hospitalized for asthma had 1.84 greater odds of a revisit to the emergency department or a rehospitalization within twelve months if they lived in the highest quartile of housing code violation tracts, compared to those living in the lowest quartile. Integrating housing and health data could highlight at-risk areas and patients for targeted interventions.

The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013

“…(9, 28) We have also looked at other locally-available variables, “geomarkers” pertaining to housing code violations and exposure to crime. (7, 8) These data are potentially less useful in other locations while the COI is currently easily accessible and available for census tracts across 100 metropolitan areas. (17) Identifying whether our findings generalize to other municipalities could further support its use across population health efforts.…”

“…(7, 8) The calculation yielded an annual hospitalization rate measured per 1,000 children per year. We calculated a total utilization rate (all hospitalizations plus all ED visits) in the same manner.…”

“…Certain area-level measures of the SDH, including the percentage of individuals below the federal poverty level, are widely available and have shown value in characterizing inequities;(9, 13) however, such measures are crude and may not be amenable to immediate action. Other measures related to housing or crime(7, 8) provide nuanced, potentially-actionable detail but are typically local. There is a need for more generalizable measures with which to examine root causes and the broader context of inequities.…”

A Road Map to Address the Social Determinants of Health Through Community Collaboration

“…Like others, we are currently exploring additional innovative ways that use shared data to highlight and map where and when resource allocation could be most impactful. 47,48 Innovative Clinical Space Clinical space and workflow may hinder family engagement and clinical-community collaboration. 49 Given considerable down time throughout primary care visits, especially in the waiting room, a redesign of the waiting room to enhance access to community resource information could benefit families.…”

Geographic Variation in Hospitalization for Lower Respiratory Tract Infections Across One County

“…Locally, our group found that measures of poverty and housing quality were associated with a return to the hospital for children with asthma. 20,31 Also, a recent study by Epstein et al 32 showed that lower neighborhood income is associated with higher severity of illness on admission to the pediatric intensive care unit across diagnoses. Such findings are not surprising given the extensive literature on the influence of socioeconomic deprivation on a child’s physical health.…”